MEDICARE: 317 NON EMERGENCY TRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184299141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	317 NON EMERGENCY TRANSPORT LLC

Provider Business Mailing Address
First Line	:	1613 INGRAM ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4245
Country	:	US
Telephone Number	:	317-601-6586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 INGRAM ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4245
Country	:	US
Telephone Number	:	317-601-6586
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA HURNS
Credential	:
Telephone Number	:	317-601-6586

Provider Enumeration Date	:	05/23/2021
Last Update Date	:	05/23/2021

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